title: Does experience in creating a robot-assisted partial nephrectomy (RAPN) programme in an academic centre impact outcomes or complication rate?
abstract: OBJECTIVE
  To evaluate the impact of increased experience in robot-assisted partial nephrectomy (RAPN) on perioperative and oncological outcomes To detail the complications encountered in establishing a RAPN programme at a tertiary referral centre and the factors associated with these complications.
  
  
  METHODS
  The initial consecutive 233 patients undergoing RAPN between March 2008 and May 2012 at our institution were identified. Patients were divided into quartiles to evaluate outcomes, and uni- and multivariate predictors of complications were calculated.
  
  
  RESULTS
  In progressive quartiles, patients tended to have more complex renal tumours as evaluated by R.E.N.A.L. nephrometry (P < 0.01) or preoperative aspects and dimensions used for an anatomical classification (PADUA) scores (P = 0.003), and percentage endophytic (P = 0.01). Developing technique increased the patients undergoing unclamped PN (P < 0.01). The mean time in the operating room (from skin incision to closure) decreased significantly from 225 to 183 min (P < 0.01) and warm ischaemia time decreased from 28 to 15 min, when clamping (P < 0.01). Clavien graded complication rate (P = 0.26) and positive margin rate (P = 0.32) was unchanged by quartile.
  
  
  CONCLUSIONS
  We show that increasing experience allows more complex tumours to be removed with similar outcomes in patients undergoing RAPN. The complication rates and perioperative outcomes were similar in four successive quartiles of an initial experience of RAPN.
authors.affiliation: Department of Urology, Wake Forest University, Winston-Salem, NC 27157-1094, USA.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: Theodore B
authors.initials: TB
authors.lastname: Manny
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Mufarrij
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D012371:Robotics; D055815:Young Adult